House Republican leaders released a 219-page health care bill Wednesday morning that pushes state governments to take the lead in reforming the system.The plan would encourage states to find their own solutions to reducing the tens of millions of uninsured people and holding down health care premiums, with bonuses from the federal government if they do so.And states would be eligible for a total of $15 billion over the next 10 years in aid for creating high-risk pools for people whom private insurance companies refuse to cover because of pre-existing health conditions. People with pre-existing conditions would pay up to 50 percent more than average for insurance coverage under the plan. States would have to cover the rest of the tab with a “stable funding source,— although the modest federal subsidy would cover a portion of the cost. Most states already have such plans, which typically are much more expensive than regular insurance and have not made much of a dent in the ranks of the uninsured.A key piece of earlier Republican drafts – tax credits that would help people afford insurance – was rejected by House Minority Leader John Boehner (R-Ohio) as too expensive.A temporary national high-risk pool in the Democratic plan would have people pay up to 25 percent more than average for coverage, and would be aided by a $5 billion federal subsidy. The Democratic high-risk pool would disappear in 2013, when a national ban on discriminating against people with pre-existing conditions would take effect.Republicans noted that millions of people with pre-existing conditions who cannot now get any coverage would have an option to buy coverage under their plan. Sixteen states do not have any high-risk pools, they note.The Republican proposal adopts some insurance reforms pushed in the Democratic plan, including a ban on lifetime limits on benefits and a prohibition on insurance companies cutting off individuals who become sick unless a person commits fraud or conceals a medical condition. The GOP plan also allows children to stay on their parents’ plans through age 25; the Democratic bill allows children to stay on their parents’ plans until age 27.But the Republican measure has no limits on annual out-of-pocket costs, nor does it provide any direct assistance for uninsured people to buy insurance. GOP leaders have argued that their plan would reduce costs, which will make it more likely that people will buy insurance.The plan also includes the ability for small businesses to band together to negotiate for lower prices and allows people to buy insurance policies across state lines to bypass state insurance mandates. It also limits medical liability lawsuits by capping noneconomic damages at $250,000 and makes a federal ban on funding abortions permanent.It was not immediately clear how the Republican bill would be paid for, although caps on medical malpractice have previously been scored as saving tens of billions of dollars.A Congressional Budget Office score has not yet been released, and Republicans did not say how much they expect their bill to cost or how many uninsured people would be covered.